title: Cost-effectiveness of pneumococcal conjugate vaccination in immunocompromised adults.
abstract: OBJECTIVE
  Pneumococcal disease is a significant problem in immunocompromised persons, particularly in HIV-infected individuals. The CDC recently updated pneumococcal vaccination recommendations for immunocompromised adults, adding the 13-valent pneumococcal conjugate vaccine (PCV13) to the previously recommended 23-valent pneumococcal polysaccharide vaccine (PPSV23). This analysis estimates the cost-effectiveness of pneumococcal vaccination strategies in HIV-infected individuals and in the broader immunocompromised adult group.
  
  
  METHODS
  Markov model-based cost-effectiveness analysis.
  
  
  METHODS
  The model considered immunocompromised persons aged 19-64 years and accounted for childhood PCV13 herd immunity; in a separate analysis, an HIV-infected subgroup was considered. PCV13 effectiveness was estimated by an expert panel; PPSV23 protection was modeled relative to PCV13 effectiveness. We assumed that both vaccines prevented invasive pneumococcal disease, but only PCV13 prevented nonbacteremic pneumonia.
  
  
  RESULTS
  In all immunocompromised individuals, a single PCV13 cost $70,937 per quality adjusted life year (QALY) gained compared to no vaccination; current recommendations cost $136,724/QALY. In HIV patients, with a longer life expectancy (22.5 years), current recommendations cost $89,391/QALY compared to a single PCV13. Results were sensitive to variation of life expectancy and vaccine effectiveness. The prior recommendation was not favored in any scenario.
  
  
  CONCLUSIONS
  One dose of PCV13 is more cost-effective for immunocompromised individuals than previous vaccination recommendations and may be more economically reasonable than current recommendations, depending on life expectancy and vaccine effectiveness in the immunocompromised.
authors.affiliation: University of Pittsburgh School of Medicine, Pittsburgh, PA, United States. smithkj2@upmc.edu
authors.forename: Kenneth J
authors.initials: KJ
authors.lastname: Smith
authors.forename: Mary Patricia
authors.initials: MP
authors.lastname: Nowalk
authors.forename: Mahlon
authors.initials: M
authors.lastname: Raymund
authors.forename: Richard K
authors.initials: RK
authors.lastname: Zimmerman
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003362:Cost-Benefit Analysis; D017408:Guidelines as Topic; D015658:HIV Infections / Q000276:immunology*; D006801:Humans; D016867:Immunocompromised Host; D008017:Life Expectancy; D008390:Markov Chains; D008875:Middle Aged; D018803:Models, Economic; D011008:Pneumococcal Infections / Q000517:prevention & control*; D022242:Pneumococcal Vaccines / Q000627:therapeutic use*; D019057:Quality-Adjusted Life Years; D014481:United States; D014611:Vaccination / Q000191:economics* / Q000379:methods; D055815:Young Adult
chemical_list: C538862:13-valent pneumococcal vaccine; C414006:23-valent pneumococcal capsular polysaccharide vaccine; D022242:Pneumococcal Vaccines
keywords: Cost-effectiveness analysis; Immunocompromising conditions; Pneumococcal vaccination